Abdominal Exam

Question 1

What is visceral pain caused by? parietal?

Answer 1

1. stimulation of the visceral pain fibers

2. stimulated of the somatic pain fibers

Question 2

What’s the most important OLDCARTS for abdominal pain?

Answer 2

Location

Question 3

What is different between General ROS and Focused ROS?

Answer 3

general is the same every time

focused is based on chief complaint

Question 4

What medications should you not miss?

Answer 4

blood thinners, NSAIDS, Narcotics, steroids

• ex. Tylenol kills our liver
• ex. narcotics cause slowed down gut motility

Question 5

Why do we care if they smoke?

Answer 5

smoking irritates lining of stomach and lead to peptic ulcer disease

Question 6

What does MJ cause?

Answer 6

cyclic vomiting syndrome

Question 7

What is the order of the physical exam?

Answer 7

inspection, auscultation, percussion, palpation

Question 8

If a man comes with stress marks, without history of obesity, what do we worry about?

Answer 8

cushions

Question 9

What is ecchymosis around the umbilicus called? around the flank?

Answer 9

1. cullens sign

2. gray turners sign

Question 10

How long do you have to listen to declare absent bowel sounds?

Answer 10

greater than 2 minutes

Question 11

What do high pitched bowel sounds indicate?

Answer 11

early intestinal obstruction

*sound like rain on metal

Question 12

What does a friction rub indicate?

Answer 12

inflammation of the peritoneal surface of an organ

• sounds like grating sounds with respiration
• *listen over liver and spleen

Question 13

What does a venous hum indicate?

Answer 13

increased collateral circulation b/t portal and systemic venous systems

• sounds like soft humming noise
• *listen over epigastric/umbilical region

Question 14

What is the normal vertical span of the liver?

Answer 14

6-12cm

Question 15

What can cause splenomegaly?

Answer 15

portal HT, blood malignancies, HIV, splenic infant, hematoma, monoculeosis

Question 16

Ascites

Answer 16

• fluid in the peritoneal cavity

- shifting dullness test or test for fluid wave

Question 17

Appendicitis

Answer 17

• infected appendix
• McBurney’s point tenderness*, Rousing’s sign**, Psoas sign, and Obturator sign
• the best
• *second best

Question 18

Biliary Colic Test

Answer 18

Murphy’s sign

Question 19

Kidney Inflammation/Distension Test

Answer 19

Lloyd’s sign (punch)

Question 20

Peritoneal inflammation

Answer 20

“acute abdomen”
-Guarding, Rigidity , Rebound tenderness

*stiff, board like abdomen –> they need surgery

Question 21

VINDICATE

Answer 21

Vascular
Infectious/inflammatory
Neoplasm
Drugs/degenerative
Idiopathic/iatrogenic
Congenital
AI/Allergic/Anatomic
Trauma
Endocrine/Environment

Question 22

What is the process for developing a DDX?

Answer 22

develop broad DDX–> Narrow DDX–> Develop working DDX–> Pursue working DDX–> Assessment and Plan